Category: Vaccine

In a significant stride towards facilitating and informing priorities in global vaccine development for endemic pathogens, the World Health Organization (WHO) has commissioned 16 "Vaccine Value Profiles" (VVPs) to be published in a groundbreaking Supplement in the journal Vaccine.

This milestone is the result of collaborations with several pathogen and vaccine experts, led by the Product Development and Research (PDR) team in WHO's Immunization, Vaccines & Biologicals department, with the primary objective of advancing the development of vaccines for pathogens that pose a substantial public health and socio-economic burden, especially in low- and middle-income countries (LMICs).

The forthcoming Supplement is set to feature value profiles focused on 16 pathogens with vaccines in late-stage clinical development. These profiles, meticulously prepared by independent teams of global subject matter experts, compile state of the art, publicly available data and information to establish the current understanding of anticipated vaccine development and implementation feasibility, use cases and potential public health impact of vaccines, once they receive licensure and are deployed for public health purposes.

Vaccine value profiles serve as comprehensive summaries of critical evidence, essential for guiding vaccine funding, research initiatives, and clinical and policy development strategies. These tools aim to serve as key resources for multiple stakeholders in the vaccine development and immunization community, to inform their investment, prioritization and strategic decision-making. The Vaccine Value Profiles are helping to inform Gavi's Vaccine Investment Strategy (VIS), facilitating evidence-based prioritization of vaccines as well as a regional and global initiative to establish priority endemic pathogens for development of new vaccines, as part of the Immunization Agenda 2030.

"These Vaccine Value Profiles have the potential to catalyze vaccine development and activate new research collaborations by providing a comprehensive understanding of what is currently known and not known about the potential value that vaccines could bring to the world. Our goal is to provide stakeholders, including R&D funders, policymakers, regulators, manufacturers, and the public, with the insights necessary to make informed decisions and accelerate the development of vaccines that will have the greatest impact, says Professor Ruth Karron from Johns Hopkins University.

The Supplement's first volume will feature the Vaccine Value Profile for respiratory syncytial virus (RSV), along with profiles for Group B Streptococcus, CMV (cytomegalovirus), Shigella, Salmonella paratyphi A, enterotoxigenic E. Coli Norovirus, and Leishmaniasis. Additionally, the issue will include commentary on neglected tropical diseases, underscoring the comprehensive scope of this monumental initiative. A second volume will follow later in 2023, and will include vaccines such as against Klebsiella pneumoniae or Neisseria gonorrhoea.

WHO extends its gratitude to all authors, the editorial team at the journal Vaccine, to Professor Mark Jit who served as special editor, and all contributors who have played an instrumental role in developing this critical tool kit. As the first volume of this Supplement is released, we will leverage learnings from these Vaccine Value Profiles to work in-step with key stakeholders to accelerate vaccine development and ensure access, to fortify global health and improve equity, particularly in - countries, says Dr Katherine OBrien, the Director of Immunization, Vaccines & Biologicals at the World Health Organization.

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Accelerating Vaccine Development for Global Health Impact - a WHO Initiative to Prioritize Key Endemic Pathogens - World Health Organization

The FDA has approved a chikungunya vaccine (Ixchiq, Valneva), making it the first approved immunization for the illness, aimed to treat individuals that are 18 years and older at high risk of being exposed to the chikungunya virus.

Image credit: Mohammad | stock.adobe.com

The chikungunya vaccine is a single dose injection that is administrated into the muscle, injecting a live and weakened form of the chikungunya virus. Following the vaccine, individuals could experience symptoms like those that have the disease.

The press release noted that within the past 15 years, 5 million cases of the chikungunya virus have been reported. Individuals that were diagnosed with the virus transmitted it through the bite of an infected mosquito carrying the disease. Tropical and subtropical regions of Africa, Southeast Asia, and parts of the Americas have the highest rate of infection due to an increased number of virus-carrying mosquitoes in those areas. Despite this, researchers are aware that the infection has spread to new geographic areas.

The virus was also found in newborn babies, transmitted from pregnant individuals with the virus present in the blood at delivery, according to the press release. The infection was reported to cause severe and possibility fatal reactions in newborns.

Infection with chikungunya virus can lead to severe disease and prolonged health problems, particularly for older adults and individuals with underlying medical conditions, said Peter Marks, MD, PhD, director of the FDAs Center for Biologics Evaluation and Research, in a press release. Todays approval addresses an unmet medical need and is an important advancement in the prevention of a potentially debilitating disease with limited treatment options.

Symptoms include fever, joint pain, rash, headache, and muscle pain. The joint pain could occur for months or years in individuals with severe infection, with few available treatment options.

The approval was granted based on 2 clinical studies conducted in North America that evaluated the safety of the chikungunya vaccine. The first study included around 3500 individuals 18 years of age and older. About 1000 participants received a placebo and the remaining individuals received a dose of the chikungunya vaccine.

Individuals who received the chikungunya vaccine reported headache, fatigue, muscle pain, joint pain, fever, nausea, and tenderness at site injection. Notably, 1.6% of individuals that received the chikungunya vaccine needed medical attention because their adverse reactions limited their daily activity and 2 individuals needed to be hospitalized. Other individuals experienced prolonged reactions that extended for 30 days. However, none of these reactions were reported among individuals that received the placebo. This caused the FDA to require further studies to examine serious risk of severe adverse reactions after receiving the vaccine.

A separate clinical study focused on analyzing the effectiveness of the vaccine. The researchers used immune response data among individuals that were 18 years and older. The researchers compared the immune response of 266 individuals that received the chikungunya vaccine to 96 individuals that received the placebo.

The level of antibody evaluated in study participants was based on a level shown to be protective in non-human primates that had received blood from people who had been vaccinated. Almost all vaccine study participants achieved this antibody level, said the study authors, in a press release.

However, in another study that assessed if the vaccine virus was present in the bloodstream to transfer to newborns, the findings were inconclusive. The study authors noted that they were also unaware if the vaccine could have adverse reactions to the newborn and advised medical professionals to consider individuals risk of exposure to the virus before administering.

Reference

FDA Approves First Vaccine to Prevent Disease Caused by Chikungunya Virus. FDA. News release. November 9, 2023. Accessed November 10, 2023. https://www.fda.gov/news-events/press-announcements/fda-approves-first-vaccine-prevent-disease-caused-chikungunya-virus.

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FDA Approves First Vaccine to Prevent Infection from Chikungunya Virus - Pharmacy Times

November 10, 2023 | Austin, Texas | Press Release

Governor Greg Abbott todaysigned a law banning COVID-19 vaccine mandates by private employers passed during Special Session #3 of the 88th Legislature at the Governors Mansion in Austin. This new law protects the personal healthcare choices and livelihoods of Texans by prohibiting private employers from requiring employees or contractors receive a COVID-19 vaccination as a condition of employment.

"Senate Bill 7 prohibits private employers from requiring employees to get a COVID vaccinationand employers that violate this law are subject to a $50,000 fine as well as a lawsuit and injunctive relief from the Texas Attorney General," said Governor Abbott. "This law adds to the law that I already signed that prohibits state and local governments from imposing COVID mandates. It's long past time to put COVID behind us and restore individual freedom to all Texans. I thank Senator Middleton, Representative Leach, and all other members of the Texas Legislature who stood with this issue every step of the way."

Earlier this year, Governor Abbott signed a similar law prohibiting any government in Texas from imposing COVID-19 vaccine mandates.

The Governor was joined at the bill signing ceremony by Senators Bob Hall and Mayes Middleton; Representatives Brad Buckley, Briscoe Cain, Cody Harris, Brian Harrison, Cole Hefner, Jeff Leach, Nate Schatzline, Mike Schofield, Steve Toth, and Cody Vasut;and other healthcare freedom advocates.

Senate Bill 7 (Middleton/Leach) prohibits private employers from requiring employees and contractors receive a COVID-19 vaccination as a condition of employment. The bill allows the Texas Workforce Commission to investigate complaints by employees, contractors, or prospective employees or contractors alleging their employer or perspective employer has taken adverse action against them for not receiving a COVID-19 vaccine.

Continued here:

Governor Abbott Signs COVID Vaccine Freedom Bill At Governor's Mansion - Office of the Texas Governor

A US reporting system designed to detect potential safety issues with vaccines is supposed to be user-friendly, responsive, and transparent. But an investigation published by The BMJ today finds it's not meeting its own standards.

The Vaccine Adverse Event Reporting System (VAERS), co-managed by the US Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA), collects reports of symptoms, diagnoses, hospitalizations, and deaths following vaccination that might indicate a possible safety concern about a vaccine, explains journalist Jennifer Block.

It relies on a mixture of voluntary adverse event reports from doctors and patients and mandatory reporting from vaccine manufacturers, which are required by law to report all adverse events of which they are aware.

According to VAERS' standard operating procedure for covid-19, reports must be processed quickly, within days of receipt.

But The BMJ has learned that in the face of an unprecedented 1.7 million reports since the rollout of the covid-19 vaccines, VAERS staffing was likely not commensurate with the demands of reviewing serious reports submitted, including reports of death.

Freedom of Information Act (FOIA) documents seen by The BMJ suggest that Pfizer has more than 1,000 more full time employees than the CDC, despite the latter's responsibility for handling adverse event reports for all manufacturers.

What's more, other countries have acknowledged deaths "likely" or "probably" related to mRNA vaccination, whereas the CDC, which says it has reviewed nearly 20,000 reports (far more than other countries) hasn't acknowledged a single death linked to mRNA vaccine.

The BMJ has spoken to more than a dozen people, including a number of physicians and a state medical examiner, who have filed VAERS reports of a serious nature on behalf of themselves or patients and were never contacted by clinical reviewers, or were contacted months later.

Some were told conflicting information about updating their report or discouraged from making a report altogether.

A group of physicians and advocates have met multiple times with representatives of the FDA between 2021 and 2022 to express their concerns that the system is not operating as intended and signals are being missed.

In response to several questions about these meetings and the issues raised therein, the FDA responded by email that the agency "is actively engaged in safety surveillance of these vaccines to identify and address potential safety concerns" and that "physicians and epidemiologists from the FDA and CDC continuously screen and analyse data from VAERS for covid-19 vaccines to identify potential signals that would indicate the need for further study."

The BMJ has also found that the FDA and CDC essentially maintain two separate VAERS databases - a public-facing database containing only initial reports, and a private, backend system containing all updates and corrections - for example, a formal diagnosis, recovery, or a death.

CDC told The BMJ that this was to protect patient confidentiality. Yet, interestingly, Block notes that the FDA's adverse event reporting system (FAERS), which collects reports on drugs, does maintain a publicly accessible database that gets updated, as does the Medical Device Reporting system, raising the question of why VAERS can't do the same.

Neither the CDC nor the FDA provided an explanation. An FDA spokesperson told The BMJ that "patients can submit formal requests under FOIA to obtain the full record of their report."

For serious cases, reporters to VAERS are supposed to receive emails prompting them for updates. It includes a code and upload link, but reporters The BMJ spoke with didn't get confirmation emails, and if they search for their report in the database it will remain unchanged. Similarly, if a reporter successfully treated their diagnoses and improved, or confirmed that the cause for their illness was unrelated to a vaccine, that would not be reflected in the public database.

Narayan Nair, the FDA division director who oversees VAERS, acknowledged in a meeting with advocates that people get frustrated when they look for an updated report, find the original untouched, and feel like they're "being ignored." "They never see it on the front end, because we don't alter that initial report."

Source:

Journal reference:

Block, J. (2023). Is the USs Vaccine Adverse Event Reporting System broken? BMJ. doi.org/10.1136/bmj.p2582.

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US reporting system to detect vaccine safety issues may not be meeting its own standards - News-Medical.Net

Texas governor signs bill barring private employers from requiring COVID vaccines

by ADELA UCHIDA | KEYE Staff

{p}Registered nurse Toby Hatton administers a dose of the Pfizer-BioNtech COVID-19 vaccine to Commissioner Dr. John William Hellerstedt of the Texas Department of State Health Services at the Ascension Seton Medical Center on Tuesday, Dec. 22, 2020. At left, Texas Gov. Greg Abbott. (Ricardo B. Brazziell /Austin American-Statesman via AP){/p}

AUSTIN, Texas (KEYE)

Texas Gov. Greg Abbott signed a bill into law Friday banning private employers from mandating their workers get the COVID-19 vaccine.

Texas%20governor%20signs%20bill%20barring%20private%20employers%20from%20requiring%20COVID%20vaccines%20(KEYE)

Senate Bill 7 is from the previous third special session. The law means if a private employer tries to make workers get the COVID-19 vaccine, they could be facing a $50,000 fine and a lawsuit from the attorney general's office.

It doesn't apply to just employees.

The text of the bill reads: An employer may not adopt or enforce a mandate requiring an employee, contractor, applicant for employment, or applicant for a contract position to be vaccinated against COVID-19 as a condition of employment or a contract position.

That makes it one of the broadest such laws in the country, according to one of its authors, Rep. Jeff Leach, a Republican from Collin County.

It covers prospective employers and prospective employees and thats part of what makes it so broad, Leach said.

SB 7 became law more than two years after Houston Methodist Hospital ousted 150 employees for refusing to get vaccinated for the coronavirus. The new law does not exempt hospitals and healthcare facilities from the ban but does allow them to require unvaccinated workers to take precautions.

Critics say the law takes away the choice for employers to manage their businesses as they see fit and makes it more dangerous for people who are medically vulnerable to be out in public.

But the Republican governor has long taken a stance against vaccine requirements, signing an executive order back in October 2021 after the Houston hospital employees were fired.

It said, in part: "No entity in Texas can compel receipt of a COVID-19 vaccine by any individual, including an employee or a consumer, who objects to such vaccination," and the bill expands those same restrictions to private businesses.

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Quantification of COVID-19 Vaccine Coercion in India: A Survey Study - Cureus

Childrens rates of vaccination in this country are at a record low, according to a Thursday report from the Centers for Disease Control and Prevention (CDC).

The report disclosed the number of American kindergarten students who started the 2022-2023 school year with an exemption from at least one of the following four state-required childhood vaccines:

Measles, mumps, and rubella vaccine (MMR)

Diphtheria, tetanus and acellular pertussis vaccine (DTaP)

Poliovirus (polio) vaccine

Varicella vaccine (protects against chickenpox)

NEW COVID VACCINE PUSH IS ANTI-HUMAN, SAYS FLORIDA SURGEON GENERAL: MAJOR SAFETY CONCERN

In the last school year, the exemption rate for these vaccines increased from 2.6% to 3%, the highest that has ever been reported in the country, per the CDC report.

Childrens rates of vaccination are at an all-time low, according to a Thursday report from the CDC. (iStock)

Exemptions rose in 41 states, with 10 states reporting exemption rates as high as 5%.

An exemption rate of 5% or greater "increases the risk for outbreaks of vaccine-preventable diseases," the CDC stated in its report.

MANY YOUNG KIDS ARE NOT GETTING LIFE-SAVING VACCINES, STUDY FINDS: CONCERNING TREND

"Overall, 3.0% of kindergartners had an exemption (0.2% medical and 2.8% non-medical) from one or more required vaccines," the report noted.

"Non-medical exemptions account for (greater than) 90% of reported exemptions, and approximately 100% of the increase in the national exemption rate."

Exemptions rose in 41 states, with 10 states reporting exemption rates as high as 5%, the report found. (iStock)

The CDC noted that "it is not clear whether this reflects a true increase in opposition to vaccination, or if parents are opting for non-medical exemptions because of barriers to vaccination or out of convenience."

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The health agency acknowledged some limitations of the study.

For example, there is some variation in vaccination requirements by state.

The CDC noted that "it is not clear whether this reflects a true increase in opposition to vaccination, or if parents are opting for non-medical exemptions because of barriers to vaccination or out of convenience." (Elijah Nouvelage/Bloomberg via Getty Images)

Also, variations in data collection times and methods could negatively impact the findings.

There is also the potential of "inaccurate or absent documentation" that could impact the data.

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The CDC called for "enforcement of school vaccination requirements, school-based vaccination clinics, reminder and recall systems, and follow-up with undervaccinated students" to help boost vaccination coverage.

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Childhood vaccinations are at an all-time low, the CDC reveals - Fox News

In India, influenza commonly known as the flu, presents a significant public health challenge. This respiratory illness is caused by the influenza virus and can range from mild to severe, with the potential for fatal outcomes. The highly contagious nature of the virus makes it imperative to address the need for flu vaccination in the country. India carries a substantial burden of influenza with outbreaks occurring throughout the year. The primary flu season typically spans from October to March affecting millions of individuals. The flu virus is easily transmitted through respiratory droplets, making it a constant threat to public health.

The flu manifests a range of symptoms, including fever, cough, sore throat, runny or stuffy nose, muscle aches, headaches, fatigue, and sometimes vomiting and diarrhea. These symptoms can severely impact an individual's daily life and, in certain cases, result in hospitalization.

The flu can lead to various complications some of which are life-threatening. These complications include pneumonia, bronchitis, sinus infections, ear infections, asthma attacks, as well as more serious events like heart attacks and strokes. Tragically, the flu can even lead to death, particularly in high-risk populations.

Several groups are at higher risk of experiencing severe complications from the flu. These include young children, older adults, individuals with chronic health conditions such as asthma, diabetes, and heart disease, pregnant women, and those with weakened immune systems. Protecting these vulnerable populations is paramount.

The flu vaccine is the most effective tool for safeguarding individuals against the flu. It is recommended for everyone above the age of 6 months. The vaccine works by exposing the body to a weakened or inactivated form of the flu virus, enabling the immune system to develop defenses against the virus.

The flu vaccine is updated annually to address the specific strains of the flu virus expected to circulate in that season. This proactive approach helps ensure that the vaccine remains effective in preventing infection. Persistent pain in the legs is not normal; check why it might be happening

Getting a flu vaccine offers numerous advantages, such as: 1.Reducing the risk of contracting the flu: The vaccine lowers the chances of falling ill due to the flu. 2.Reducing the risk of severe complications: It can prevent serious complications that may require hospitalization. 3.Lowering the risk of hospitalization: Vaccinated individuals are less likely to be hospitalized due to flu-related issues. 4.Reducing mortality risk: The vaccine significantly decreases the likelihood of succumbing to the flu.

In India, flu vaccines are readily available in most hospitals, clinics, and even at certain pharmacies and schools. The need for flu vaccination in India is clear. Influenza poses a serious threat to public health, particularly among high-risk groups, and immunization through the flu vaccine is the most effective strategy for prevention. It is safe, accessible, and offers substantial benefits, ultimately reducing the burden of this contagious and potentially life-threatening virus in India. To protect your health and that of your community, getting a flu vaccine is not just a recommendation but a responsibility.

(Author: Dr Anantha Padmanabha, consultant, internal medicine, Fortis Hospital, Nagarbhavi, Bengaluru)

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The vital need for flu vaccination in India - IndiaTimes

Summary

What is already known about this topic?

From the 201920 to the 202122 school year, national coverage with state-required vaccines among kindergartners declined from 95% to approximately 93%, ranging from 92.7% for diphtheria, tetanus, and acellular pertussis vaccine (DTaP) to 93.1% for polio.

What is added by this report?

During the 202223 school year, coverage remained near 93% for all reported vaccines, ranging from 92.7% for DTaP to 93.1% for measles, mumps, and rubella and polio. The exemption rate increased 0.4 percentage points to 3.0%. Exemptions increased in 41 states, exceeding 5% in 10 states.

What are the implications for public health practice?

Exemptions >5% limit the level of achievable vaccination coverage, which increases the risk for outbreaks of vaccine-preventable diseases. Vaccination before school entry or during provisional enrollment periods could reduce exemptions resulting from barriers to vaccination during the COVID-19 pandemic.

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U.S. states and local jurisdictions set vaccination requirements for school attendance and conditions and procedures for exemptions from these requirements. States annually report data to CDC on the number of children in kindergarten who meet, are exempt from, or are in the process of meeting requirements. National- and state-level estimates for complete vaccination with measles, mumps, and rubella vaccine (MMR); diphtheria, tetanus, and acellular pertussis vaccine (DTaP); poliovirus vaccine (polio); and varicella vaccine (VAR); exemptions from vaccination; and legally allowed kindergarten attendance while meeting requirements were based on data reported by 49 states and the District of Columbia (DC) for the 202223 school year. This kindergarten class became age-eligible to complete most state-required vaccinations during the COVID-19 pandemic. National coverage remained near 93% for all vaccines; exemptions were low but increased to 3%, compared with those during the 202122 school year (2.6%). At the state level, coverage with MMR, DTaP, polio, and VAR decreased in 29, 31, 28, and 25 states, respectively, compared with coverage during the 202122 school year. Exemptions increased in 40 states and DC, with 10 states reporting an exemption from at least one vaccine for >5% of kindergartners. Schools and providers should work to ensure that students are vaccinated before school entry, such as during the enrollment process, which is often several months before school starts. State and local provisional enrollment periods that allow students to attend school while on a catch-up schedule also provide the opportunity to fully vaccinate students and to prevent nonmedical exemptions resulting from lingering undervaccination due to COVID-19 pandemicrelated barriers to vaccination, such as reduced access to vaccination appointments.

State and local school vaccination requirements promote vaccination to protect students, schools, and communities against vaccine-preventable diseases (1). After 10 years of near 95% nationwide vaccination coverage, measles, mumps, and rubella vaccine (MMR)*; diphtheria, tetanus, and acellular pertussis vaccine (DTaP); poliovirus vaccine (polio); and varicella vaccine (VAR) coverage declined approximately 1 percentage point during the 202021 school year and fell an additional percentage point during the 202122 school year, to approximately 93% (2). For both the 202021 and 202122 school years, states reported impacts of the COVID-19 pandemic and response for both vaccine administration and data collection (3,4). This analysis summarizes data collected and reported by state and local immunization programs** on vaccination coverage and exemptions to vaccination among kindergartners in 49 states and the District of Columbia (DC), and provisional enrollment or grace period status for kindergartners in 28 states for the 202223 school year.

As mandated by state and local school entry requirements, either parents provide childrens vaccination or exemption documentation to schools, or schools obtain records from state immunization information systems. Federally funded immunization programs work with departments of education, local health departments, school nurses, and other school personnel to assess the vaccination and exemption status of children enrolled in public and private kindergartens and to report unweighted counts, aggregated by school type, to CDC via a questionnaire in the Secure Access Management System, a federal, web-based platform that provides authorized personnel with secure access to public health applications operated by CDC. CDC uses these data to produce state- and national-level estimates of vaccination coverage among children in kindergarten. During the 202223 school year, 49 states and DC reported coverage with all state-required vaccines and exemption data for public school kindergartners; 48 states and DC reported coverage with all state-required vaccines and exemption data for private school kindergartners. Data from cities were included with their state data. State-level, national, and median coverage with the state-required number of DTaP, MMR, polio, and VAR doses are reported. Hepatitis B vaccination coverage is not included in this report but is available at SchoolVaxView (2). Twenty-eight states reported the number of kindergartners who were attending school under a grace period (attendance without proof of complete vaccination or exemption during a set number of days) or provisional enrollment (school attendance while completing a catch-up vaccination schedule). All counts were current as of the time of the assessment by the state immunization program.***

National estimates, medians, and summary measures include only U.S. states and DC. Vaccination coverage and exemption estimates were adjusted on the basis of survey type and response rate. National estimates measure coverage and exemptions among all kindergartners, whereas medians indicate the midpoint of state-level coverage, irrespective of population size. During the 202223 school year, immunization programs reported 3,832,381 children enrolled in kindergarten in 49 states and DC. Reported estimates are based on 3,559,366 (92.9%) children who were surveyed for vaccination coverage, 3,711,948 (96.9%) surveyed for exemptions, and 2,683,880 (70.0%) surveyed for grace period and provisional enrollment status. Potentially achievable coverage with MMR (the sum of the percentage of children who were up to date with 2 doses of MMR and those not up to date but nonexempt) was calculated for each state. Nonexempt students (those who do not have medical or nonmedical exemptions and who are not up to date) include those who were provisionally enrolled in kindergarten, in a grace period, or otherwise without documentation of complete vaccination. Vaccination assessments varied by state because of differences in required vaccines and required numbers of doses, vaccines assessed, methods of data collection, and data reported (Supplementary Table 1, https://stacks.cdc.gov/view/cdc/134738). Kindergartners were considered up to date with a given vaccine if they received all doses for that vaccine required for school entry, except in nine states that reported kindergartners as up to date for any vaccine only if they had received all doses of all vaccines required for school entry. All but four states reported the number of kindergartners with an exemption for least one vaccine.**** SAS software (version 9.4; SAS Institute) was used for all analyses. This activity was reviewed by CDC, deemed not research, and was conducted consistent with applicable federal law and CDC policy.

Nationally, 2-dose MMR coverage was 93.1% (range=81.3% [Idaho] to 98.4% [Mississippi]), with coverage of 95% reported by 13 states and <90% by 12 states and DC (Table). DTaP coverage was 92.7% (range=81.0% [Idaho] to 98.4% [Mississippi]); 95% coverage was reported by 11 states and <90% by 14 states and DC. Polio coverage was 93.1% (range=81.8% [Idaho] to 98.4% [Mississippi]), with 95% coverage reported by 13 states and <90% by 12 states and DC. VAR coverage was 92.9% (range=80.7% [Idaho] to 98.4% [Mississippi]), with 11 states reporting 95% coverage and 12 states and DC reporting <90% coverage. Coverage during the 202223 school year decreased in most states for all vaccines compared with the 202122 school year. (Supplementary Figure, https://stacks.cdc.gov/view/cdc/134740).

Overall, 3.0% of kindergartners had an exemption (0.2% medical and 2.8% nonmedical) from one or more required vaccines (not limited to MMR, DTaP, polio, and VAR) during 202223 (range=<0.1% [West Virginia] to 12.1% [Idaho]), compared with 2.6% reported during the 202122 school year (Supplementary Table 2, https://stacks.cdc.gov/view/cdc/134739). Exemptions from receipt of one or more vaccines increased in 40 states and DC and increased by at least 1 percentage point in seven states (Figure 1). Nonmedical exemptions account for >90% of reported exemptions, and approximately 100% of the increase in the national exemption rate. Provisional enrollment or grace period attendance in kindergarten was 2.5% among 28 states reporting these data (range=0.5% [Georgia and Hawaii] to 9.2% [Arkansas]). Nationwide, 3.9% of kindergarten students were not fully vaccinated with MMR and nonexempt. Among the 36 states and DC with MMR coverage <95% during the 202223 school year, 10 states reported that >5% of kindergartners were exempt. All but these 10 states could potentially achieve 95% MMR coverage if all nonexempt, not up-to-date children were vaccinated, compared with all but four states during the 202122 school year (Figure 2).

During the 202223 school year, nationwide vaccination coverage among kindergarten children remained approximately 93% for MMR, DTaP, polio, and VAR, similar to that in the 202122 school year, lower than the 94% coverage in the 202021 school year, and lower still than the 95% coverage during the 201920 school year, when children were vaccinated before the COVID-19 public health emergency (24). National MMR coverage among kindergarten students remained below the Healthy People 2030 target of 95% (5) for the third consecutive year. Coverage with all four vaccines declined in a majority of states. To address pandemic-related declines in routine immunization coverage across the lifespan, CDC launched the Lets RISE initiative earlier in 2023 and is providing a broad range of communication and enhanced technical assistance, including back-to-school campaigns, to jurisdictions to get routine vaccination coverage back to prepandemic levels as quickly and equitably as possible.

The overall percentage of children with an exemption increased from 2.6% during the 202122 school year to 3.0% during the 202223 school year, the highest exemption rate ever reported in the United States (2). The percentage of children with an exemption increased in 40 states and DC. To achieve the Healthy People 2030 target of 95% MMR coverage, exemptions cannot exceed 5%. State-level exemption rates in excess of 5% prevent 10 states from potentially achieving 95% MMR coverage even if all nonexempt kindergartners in 202223 were vaccinated, up from four states in 202122. National MMR coverage of 93.1% during the 202223 school year translates to approximately 250,000 kindergartners who are at risk for measles infection.

The findings in this report are subject to at least four limitations. First, comparisons among states are limited because of variation in state requirements: which vaccines are required, the number of doses required, the date required, the type of documentation accepted, data collection methods, allowable exemptions, definitions of grace period, and provisional enrollment. Second, representativeness might be negatively affected by data collection methods that assess vaccination status at different times, or miss some schools or students (e.g., homeschooled students). Third, vaccination coverage, exemption rates, grace period, or provisional enrollment might be under- or overestimated because of inaccurate or absent documentation. Finally, national coverage estimates for the 202223 school year include only 49 of 50 states and DC, and nine states use lower bound estimates; exemption estimates include 49 states and DC, and five states use lower bound estimates.

Nationwide vaccination coverage among kindergarten students remains below prepandemic levels, and exemptions have increased. Because clusters of undervaccinated children can lead to outbreaks (68), it is important for immunization programs, schools, and providers to make sure children are fully vaccinated before school entry, or before provisional enrollment periods expire. In previous years, nearly all states had the potential to achieve 95% coverage if all nonexempt students were vaccinated, but increases in state-level exemptions have reduced that number by 17%, from 48 in 202021 to 40 in 202223. Exemptions in excess of 5% limit the level of vaccination coverage that can be achieved, which increases the risk of outbreaks of vaccine-preventable diseases. It is not clear whether this reflects a true increase in opposition to vaccination, or if parents are opting for nonmedical exemptions because of barriers to vaccination or out of convenience. Whether because of an increase in hesitancy or barriers to vaccination, the COVID-19 pandemic affected childhood routine vaccination (9). Enforcement of school vaccination requirements, school-based vaccination clinics, reminder and recall systems, and follow-up with undervaccinated students have already been shown to be effective in increasing vaccination coverage (10). A better understanding of the reasons behind nonmedical exemptions increasing in 40 states and DC, and their impact, could help develop policies that would complement those interventions, to bring higher vaccination coverage and protection against vaccine-preventable diseases within reach of more states.

1Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC; 2Certified Technical Experts, Inc., Montgomery, Alabama; 3Association of Schools and Programs of Public Health, Washington, DC.

Abbreviations: DTaP=diphtheria, tetanus, and acellular pertussis vaccine; DTP=diphtheria and tetanus toxoids and pertussis vaccine; MMR=measles, mumps, and rubella vaccine; polio=poliovirus vaccine; NA=not available; NP=no grace period or provisional policy; NR=not reported to CDC; NReq=not required; NYC=New York City; PP=percentage point; VAR=varicella vaccine. * Estimates adjusted for nonresponse and weighted for sampling where appropriate. Estimates based on a completed vaccination series (i.e., not vaccine-specific) use the symbol. Coverage might include history of disease or laboratory evidence of immunity. In Kentucky, public schools reported numbers of children up to date with specific vaccines, and most private schools reported numbers of children who received all doses of all vaccines required for school entry. A grace period is a set number of days during which a student can be enrolled and attend school without proof of complete vaccination or exemption. Provisional enrollment allows a student without complete vaccination or exemption to attend school while completing a catch-up vaccination schedule. In states with one or both of these policies, the estimates represent the number of kindergartners who were within a grace period, were provisionally enrolled, or were in a combination of these categories. Some programs did not report the number of children with exemptions, but instead reported the number of exemptions for each vaccine, which could count some children more than once. Lower bounds of the percentage of children with any exemptions were estimated using the individual vaccines with the highest number of exemptions. Estimates based on vaccine-specific exemptions use the symbol. ** Exemptions, grace period or provisional enrollment, and vaccine coverage status might not be mutually exclusive. Some children enrolled under a grace period or provisional enrollment might be exempt from one or more vaccinations, and children with exemptions might be fully vaccinated with one or more required vaccines. Includes five territories and three freely associated states. The kindergarten population is an approximation provided by each program. The number surveyed represents the number surveyed for coverage. Exemption estimates are based on 30,224 kindergartners for Kansas, 58,878 for South Carolina, and 92,424 for Virginia. *** Most states require 2 doses of MMR; Alaska, New Jersey, and Oregon require 2 doses of measles, 1 dose of mumps, and 1 dose of rubella vaccines. Georgia, New York, New York City, North Carolina, and Virginia require 2 doses of measles and mumps vaccines and 1 dose of rubella vaccine. Iowa requires 2 doses of measles vaccine and 2 doses of rubella vaccine. Wyoming requires 1 dose of MMR for kindergarten entry, allowing students until the day before their seventh birthday to receive their second dose, but reported kindergarten coverage with 2 doses of MMR at the time of the assessment. Pertussis vaccination coverage might include some DTP doses if administered in another country or by a vaccination provider who continued to use DTP after 2000. Most states require 5 doses of DTaP for school entry, or 4 doses if the fourth dose was received on or after the fourth birthday; Maryland and Wisconsin require 4 doses; Nebraska requires 3 doses. The reported coverage estimates represent the percentage of kindergartners with the state-required number of DTaP doses, except for Kentucky, which requires 5 but reports 4 doses of DTaP. Wyoming requires 4 doses of DTaP for kindergarten entry, allowing students until the day before their seventh birthday to receive their fifth dose, but reported kindergarten coverage with 5 doses of DTaP at the time of the assessment. Most states require 4 doses of polio vaccine for school entry, or 3 doses if the fourth dose was received on or after the fourth birthday; Maryland and Nebraska require 3 doses. The reported coverage estimates represent the percentage of kindergartners with the state-required number of polio doses, except for Kentucky, which requires 4 but reports 3 doses of polio. Wyoming requires 3 doses of polio for kindergarten entry, allowing students until the day before their seventh birthday to receive their fourth dose, but reported kindergarten coverage with 4 doses of polio at the time of the assessment. Most states require 2 doses of VAR for school entry; Alabama, Arizona, New Jersey, Oklahoma, and Oregon require 1 dose. Reporting of VAR status for kindergartners with a history of varicella disease varied within and among states; some kindergartners were reported as vaccinated against varicella and others as medically exempt. Wyoming requires 1 dose of VAR for kindergarten entry, allowing students until the day before their seventh birthday to receive their second dose, but reported kindergarten coverage with 2 doses of VAR at the time of the assessment. **** National coverage and exemption estimates and medians were calculated using data from 49 states and the District of Columbia (i.e., did not include American Samoa, Federated States of Micronesia, Guam, Houston, Marshall Islands, Montana, Northern Mariana Islands, NYC, Palau, Puerto Rico, and the U.S. Virgin Islands). National grace period or provisional enrollment estimates and medians were calculated using data from the 28 states that have either a grace period or provisional enrollment policy and reported relevant data to CDC. Data reported from 3,559,366 kindergartners were assessed for coverage, 3,711,948 for exemptions, and 2,683,880 for grace period or provisional enrollment. Estimates represent rates for populations of coverage and exemptions (3,832,381), and grace period or provisional enrollment (2,763,250). The proportion surveyed is reported as 100% but might be <100% if based on incomplete information about the actual current enrollment. Philosophical exemptions were not allowed. Reported public school data only. ***** Religious exemptions were not allowed. Counted some or all vaccine doses received regardless of Advisory Committee on Immunization Practicesrecommended age and time interval; vaccination coverage rates reported might be higher than those for valid doses. Did not include certain types of schools, such as kindergartens in child care facilities, online schools, correctional facilities, or those located on military bases or tribal lands. Vaccination coverage data were collected from a sample of kindergartners; exemption data were collected from a census of kindergartners. ****** Utah changed the way data were reported between the 202122 and 202223 school years and is excluded from this analysis.

* Montana did not report kindergarten vaccination coverage for the 202122 and 202223 school years and is excluded from this analysis. Utah changed the way data were reported between the 202122 and 202223 school years and is excluded from this analysis.

Abbreviations: MMR = measles, mumps, and rubella vaccine; UTD = up to date.

* Jurisdictions are ranked from lowest to highest potentially achievable coverage. Potentially achievable coverage is estimated as the sum of the percentage of students with UTD MMR and the percentage of students without UTD MMR and without a documented vaccine exemption. Montana did not report kindergarten vaccination coverage for the 202122 and 202223 school years and is excluded from this analysis.

The exemptions used to calculate the potential increase in MMR coverage for Alaska, Arizona, Arkansas, Colorado, Delaware, District of Columbia, Idaho, Illinois, Maine, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, Nevada, New York, North Carolina, Oklahoma, Oregon, Rhode Island, Texas, Utah, Vermont, Washington, Wisconsin, and Wyoming are the number of children with exemptions specifically for MMR. For all other jurisdictions, numbers are based on an exemption for any vaccine.

Potentially achievable coverage in Alaska, Arizona, Hawaii, Idaho, Michigan, Nevada, North Dakota, Oregon, Utah, and Wisconsin is <95%.

Suggested citation for this article: Seither R, Yusuf OB, Dramann D, Calhoun K, Mugerwa-Kasujja A, Knighton CL. Coverage with Selected Vaccines and Exemption from School Vaccine Requirements Among Children in Kindergarten United States, 202223 School Year. MMWR Morb Mortal Wkly Rep 2023;72:12171224. DOI: http://dx.doi.org/10.15585/mmwr.mm7245a2.

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Coverage with Selected Vaccines and Exemption from School Vaccine Requirements Among Children in Kindergarten ... - CDC